Bladder control: Medications for urinary problems

You've given up coffee and soda. You've followed your doctor's suggestions for bladder retraining. But bladder control remains a problem. What else can you do? Ask your doctor about medication options.

Medications are available for people with bladder control problems marked by sudden, intense urinary urges and urine leakage (overactive bladder and urge incontinence). Fewer medication options exist for urine leakage prompted by movement or activity, such as coughing, sneezing or heavy lifting (stress incontinence).

Here's a look at medications commonly prescribed to treat urinary incontinence and their possible side effects. Keep in mind that medication combined with behavioral treatment might be more effective than medication alone.

Anticholinergics

How they work

Anticholinergic drugs block the action of a chemical messenger — acetylcholine — that sends signals to your brain that trigger abnormal bladder contractions associated with overactive bladder. These bladder contractions can make you feel the need to urinate even when your bladder isn't full.

Anticholinergic medications include:

Oxybutynin (Ditropan XL, Oxytrol)

Tolterodine (Detrol)

Darifenacin (Enablex)

Solifenacin (Vesicare)

Trospium

Fesoterodine (Toviaz)

These medications are usually given as a pill or tablet that you take by mouth. Oxybutynin is also available as a cream or skin patch that delivers a continuous amount of medication.

It can take several weeks before your symptoms begin to improve on this type of medication. It might take 12 weeks to have the full effect.

Side effects

The most common side effects of anticholinergics are dry mouth and constipation. An extended-release form, which you take once a day, might cause fewer side effects than the immediate-release versions, which are usually taken multiple times a day.

To counteract dry mouth, try sucking hard candy or chewing gum to produce more saliva. Other less common side effects include heartburn, blurry vision, rapid heartbeat (tachycardia), flushed skin, urinary retention and cognitive side effects, such as impaired memory and confusion.

If you use the oxybutynin skin patch, it might cause skin irritation. Your doctor might suggest that you rotate the location of your patch.

Mirabegron (Myrbetriq)

How it works

Mirabegron is a medication approved to treat certain types of urinary incontinence. It relaxes the bladder muscle and can increase the amount of urine your bladder can hold. It might also increase the amount you are able to urinate at one time, helping to empty your bladder more completely.

Side effects

Some common side effects of mirabegron include nausea, diarrhea, constipation, dizziness and headache. It can increase blood pressure, so your blood pressure should be monitored while on this drug.

In addition, it interacts with various medications, so make sure your doctor knows which medications you're taking before you begin taking mirabegron.

Onabotulinumtoxin type A (Botox)

How it works

Injections of Botox into the bladder muscle might benefit people who have an overactive bladder. Botox blocks the actions of acetylcholine and paralyzes the bladder muscle.

Botox might be helpful for people who haven't responded to other medications. Benefits can last several months. Your doctor might recommend repeat injections once or twice a year.

Side effects

Studies have found that Botox significantly improves symptoms of incontinence and causes few side effects. Some research indicates it may increase urinary tract infections, but the data aren't conclusive.

The Food and Drug Administration (FDA) warns that adverse reactions including respiratory arrest and death may occur after the use of Botox for both approved and unapproved uses.

Estrogen

How it works

After menopause, a woman's body produces less estrogen. This drop in estrogen may contribute to deterioration of the supportive tissues around the bladder and urethra, weakening the tissues and potentially aggravating stress incontinence.

Applying low-dose, topical estrogen in the form of a vaginal cream, an estrogen-containing ring or a patch may help rejuvenate deteriorating tissues in the vagina and urinary tract and relieve some incontinence symptoms.

Topical estrogen might not be recommended if you have a history of breast cancer, uterine cancer or both. Talk with your doctor about the potential risks.

Combination hormone replacement therapy (estrogen plus progestin) isn't the same as topical estrogen and is no longer used to treat urinary incontinence. Oral estrogen replacement also is not the same as topical estrogen, and it might worsen incontinence symptoms.

Side effects

Imipramine

How it works

Imipramine (Tofranil) is a tricyclic antidepressant. It makes the bladder muscle relax, while causing the smooth muscles at the bladder neck to contract. It may be used to treat mixed incontinence — a combination of urge and stress incontinence.

Imipramine can cause drowsiness, so it's often taken at night. Because of this, imipramine may be useful for nighttime incontinence, as well. It may also be helpful for children who bed-wet at night (nocturnal enuresis). Imipramine is usually not a good fit for older adults.

Side effects

Serious side effects from imipramine are rare but can include cardiovascular problems, such as irregular heartbeat and dizziness or fainting from reduced blood pressure when you stand up quickly. Children and older adults may be especially susceptible to these side effects.

Other side effects, including dry mouth, blurry vision and constipation, are similar to those of anticholinergics. Tricyclic antidepressants interact with various medications, so make sure your doctor knows the other medications you're taking.

Duloxetine

How it works

Duloxetine (Cymbalta) is a serotonin and norepinephrine reuptake inhibitor that is approved to treat depression and anxiety. It can help the urethral sphincter relax, so it can improve urinary incontinence in some women. It might be especially helpful for women who have urinary incontinence and depression.

Side effects

Side effects of duloxetine can include nausea, dry mouth, dizziness, constipation, insomnia and fatigue. Women who have chronic liver disease should not take duloxetine. Be sure your doctor knows your full medical history before you begin using this drug.

See your doctor

When talking to your doctor, carefully review all the medications you're taking, including over-the-counter drugs or herbal remedies. Some medications make bladder control problems worse. Others can interact with incontinence medications in a way that increases symptoms.

Your doctor can help you decide if you need medicine to treat your bladder control problem and, if so, which one might be best for you.

Bladder control problems in women (urinary incontinence). National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/urologic-diseases/bladder-control-problems-women. Accessed May 9, 2017.

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